85 results on '"Papathemelis T"'
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2. Entzündliche Erkrankungen der Adnexe
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Serno, J., Papathemelis, T., Maass, N., Dimpfl, Thomas, editor, Janni, Wolfgang, editor, Kreienberg, Rolf, editor, Maass, Nicolai, editor, Ortmann, Olaf, editor, Strowitzki, Thomas, editor, Vetter, Klaus, editor, and Zimmermann, Roland, editor
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- 2015
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3. Vulvakarzinom
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Zeppernick, F., Kupec, T., Zalewski, M., Papathemelis, T., Maass, N., Dimpfl, Thomas, editor, Janni, Wolfgang, editor, Kreienberg, Rolf, editor, Maass, Nicolai, editor, Ortmann, Olaf, editor, Strowitzki, Thomas, editor, Vetter, Klaus, editor, and Zimmermann, Roland, editor
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- 2015
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4. Gynäkologische Notfälle
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Serno, J., Papathemelis, T., and Maass, N.
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- 2015
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5. Laparoskopie in der gynäkologischen Onkologie
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Meinhold-Heerlein, I., Papathemelis, T., Wölfler, M., and Maass, N.
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- 2014
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6. Does Any Imaging Method Allow Distinguishing Between Myoma and Sarcoma?
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Serno, J., Meinhold-Heerlein, I., Schrading, S., and Papathemelis, T.
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- 2015
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7. Vulvakarzinom
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Zeppernick, F., Kupec, T., Zalewski, M., Papathemelis, T., and Maass, N.
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- 2013
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8. Entzündliche Erkrankungen der Adnexe
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Serno, J., Papathemelis, T., and Maass, N.
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- 2013
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9. Entzündliche Erkrankungen der Adnexe
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Serno, J., primary, Papathemelis, T., additional, and Maass, N., additional
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- 2014
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10. Vulvakarzinom
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Zeppernick, F., primary, Kupec, T., additional, Zalewski, M., additional, Papathemelis, T., additional, and Maass, N., additional
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- 2014
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11. Gutartige Uterustumoren
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Papathemelis, T.
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- 2012
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12. Netze in der Primär- und Rezidivtherapie des Prolapses: Ein Update
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Najjari, L., Kaldenhoff, E., Papathemelis, T., and Maass, N.
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- 2013
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13. Endometriose in der uterinen Sectionarbe
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Donutiu, R, additional, Scharl, A, additional, Hauzenberger, T, additional, Tsaousidis, G, additional, and Papathemelis, T, additional
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- 2020
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14. Managment bei kombinierter Plazenta preavia totalis und increta/percreta
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Donutiu, R, additional, Hauzenberger, T, additional, Erhardt, I, additional, Jurovich, P, additional, Scharl, A, additional, and Papathemelis, T, additional
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- 2020
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15. Protein and mRNA Expression Levels of Interleukin-17A, -17F and -22 in Blood and Skin Samples of Patients with Mycosis Fungoides
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Papathemeli, D, primary, Patsatsi, A, additional, Papanastassiou, D, additional, Koletsa, T, additional, Papathemelis, T, additional, Avgeros, C, additional, Pikou, O, additional, Lazaridou, E, additional, and Georgiou, E, additional
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- 2020
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16. Einfluss des Lymphknotenstatus und der Behandlungsstrategie auf das Gesamtüberleben bei Gebärmutterhalskrebs im fortgeschrittenen Stadium
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Knobloch, S, Papathemelis, T, Gerken, M, Scharl, A, Anapolski, M, Ignatov, A, Ortmann, O, Scharl, S, and Klinkhammer-Schalke, M
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund und Fragestellung: Das Fehlen von Prognosedaten behindert die Implementierung einer optimalen Therapie für Gebärmutterhalskrebs. Die empfohlene Therapie für FIGO IIB-Gebärmutterhalskrebs ist beispielsweise eine radikale Hysterektomie oder Radiochemotherapie. Da eine Operation[zum vollständigen Text gelangen Sie über die oben angegebene URL], 18. Deutscher Kongress für Versorgungsforschung (DKVF)
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- 2019
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17. Gibt es einen Vorteil der Lymphadenektomie für die Gesamt- und rezidivfreie Überlebenszeit beim Endometriumkarzinom Typ I FIGO IB G1-2? Eine retrospektive bevölkerungsbasierte Kohortenanalyse
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Hassas, D, Papathemelis, T, Gerken, M, Scharl, S, Scharl, A, Lux, MP, Beckmann, MW, Ortmann, O, and Klinkhammer-Schalke, M
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund und Fragestellung: Die empfohlene Therapie für Patientinnen mit Typ I FIGO IB Endometriumkarzinom ist die Hysterektomie und die Adnexektomie. Die therapeutischen Vorteile einer zusätzlichen Becken- und Paraaortal-Lymphknotendissektion (LND) werden jedoch noch diskutiert. In dieser[zum vollständigen Text gelangen Sie über die oben angegebene URL], 18. Deutscher Kongress für Versorgungsforschung (DKVF)
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- 2019
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18. Erratum zu: Netze in der Primär- und Rezidivtherapie des Prolapses. Ein Update
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Najjari, L., Kaldenhoff, E., Papathemelis, T., and Maass, N.
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- 2013
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19. Die richtige Therapie für die richtige Patientin – personalisierte Behandlung des Mammakarzinoms
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Scharl, A., additional, Kühn, T., additional, Papathemelis, T., additional, and Salterberg, A., additional
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- 2015
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20. The Right Treatment for the Right Patient – Personalised Treatment of Breast Cancer
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Scharl, A., additional, Kühn, T., additional, Papathemelis, T., additional, and Salterberg, A., additional
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- 2015
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21. Embolisation der Arteriae uterinae bds. in Kombination mit Methotrexat-Applikation bei einer Zervikalgravidität im 2. Trimenon bei bestehender vaginaler Blutung: Case report
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Anapolski, M, primary, Papathemelis, T, additional, Dall, P, additional, Fürst, G, additional, Bender, HG, additional, and Mohrmann, S, additional
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- 2007
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22. Endometrial Cancer - Long-Term Survival in Certified Cancer Centers and Non-Certified Hospitals: Comparative Analysis Based on a Large German Retrospective Cohort Study (WiZen).
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Hansinger J, Völkel V, Gerken M, Schoffer O, Wimberger P, Bierbaum V, Bobeth C, Rößler M, Dröge P, Ruhnke T, Günster C, Tol KK, Link T, Kast K, Papathemelis T, Ortmann O, Schmitt J, and Klinkhammer-Schalke M
- Abstract
Introduction Endometrial cancer is the most common malignant tumor of the female genital organs. In Germany, treatment is provided in both cancer centers certified by the German Cancer Society (Deutsche Krebsgesellschaft, DKG) and in non-certified hospitals. This study investigated whether treatment in DKG-certified centers leads to improved overall survival of patients with endometrial cancer. Materials and Methods Data from 11 legally independent German statutory health insurance (SHI) funds of the AOK were analyzed as well as data from four clinical cancer registries (CCR), resulting in inclusion of 30 102 AOK patients and 8190 registry patients with a diagnosis (incidental cases) of ICD-10-GM code C54 (malignant neoplasm of corpus uteri). For comparative survival analyses, multivariable Cox regressions and Kaplan-Meier analyses were used. Results The Kaplan-Meier estimator for 5-year overall survival was 66.7% for patients from certified centers and 65.0% for patients from non-certified hospitals (using SHI data; CCR data: 63.4% vs. 60.7%). Cox regression adjusted for relevant confounders showed a hazard ratio (HR) of 0.93 (SHI data; 95% CI 0.86 - 1.00; p = 0.050) and 0.935 (CCR data; 95% CI 0.827 - 1.057; p = 0.281) for all-cause mortality. In a subgroup analysis (CCR), patients with International Union against Cancer Control (UICC) stage I had a significant survival benefit if treated in a certified center (HR 0.783; 95% CI 0.620 - 0.987; p = 0.038). Conclusion The study presented herein shows that patients with endometrial cancer treated in a certified cancer center tend to have better survival rates. This should be considered when selecting the treating hospital., Competing Interests: Conflict of Interest OS, VB, CB, and JS work in a university hospital with certified cancer centers, where MR also worked previously. They received grants from the Innovation Fund of the Federal Joint Committee when carrying out the study. Outside of the submitted work, JS received institutional grants for investigator-initiated research from the G-BA, the BMG, BMBF, the EU, the German Federal State of Saxony, Novartis, Sanofi, ALK, and Pfizer. He also took part in advisory board meetings as a paid consultant for Sanofi, Lilly, and the ALK. Outside of the submitted work, OS was a paid consultant for Novartis. He is also a member of the certification committee “Skin Cancer Centers” of the German Cancer Society and a member of the panel of experts for the project “Research into criteria to evaluate certificates and quality seals in accordance with Sec. 137a para. 3 sentence 2 No. 7 SGB V” for the Institute for Quality Assurance and Transparency in Healthcare (IQTIG). PW heads the DKG-certified Breast and Gynecological Cancer Center at the university hospital of the TU Dresden and is an additional member of the Board of Directors of NCT Dresden. PW receives institutional grants for investigator-initiated research from the DFG, Krebshilfe, Sächsische Aufbaubank (SAB), Gynäko-Onkologische Forschungsstiftung, Amgen, AstraZeneca, MSD, Novartis, Pfizer, Roche, Clovis, and GSK. PW receives honoraria as an advisory board member for Amgen, AstraZeneca, MSD, Novartis, Pfizer, Lilly, Roche, Teva, Eisai, Gilead, GSK, and Daiichi Sankyo. OO works in a certified breast cancer center, gynecological cancer center, and oncological center. OO is a member of the Executive Board of the German Cancer Society, head of the University Cancer Center Regensburg, and a member of the Board of Directors of CCC WERA. TL works in a certified breast and gynecological cancer center. TL has received honoraria (lectures/consultancy work/travel costs) from Novartis, Roche, Amgen, GSK, Pfizer, Gilead, Daiichi Sankyo, AstraZeneca, Lilly, Myriad, MSD, and Esai. TP is head of a DKG-certified breast and gynecological cancer center. St. Marien Amberg Medical Center is also an oncology center according to the criteria of the DKG. The other authors state that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)
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- 2024
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23. Treatment of endometrial cancer from 2000 to 2020 in Germany: a retrospective population based cohort study.
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Papathemelis T, Ortmann O, Kohl C, Neuser P, Tol KK, Klinkhammer-Schalke M, Ugocsai P, Walter CB, Rottmann M, Real C, Justenhoven C, Robers G, Schneider C, Gerken M, Sackmann A, and Kim-Wanner SZ
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- Humans, Female, Retrospective Studies, Germany epidemiology, Aged, Middle Aged, Registries, Aged, 80 and over, Combined Modality Therapy, Adult, Prognosis, Survival Rate, Endometrial Neoplasms therapy, Endometrial Neoplasms epidemiology, Endometrial Neoplasms pathology, Endometrial Neoplasms mortality
- Abstract
Purpose: Endometrial cancer (EC) is one of the most common malignancies among women in western countries. This study aimed to assess data on patient treatment in Germany throughout two decades to evaluate the development and effect of surgery, radiation, and chemotherapy., Methods: This retrospective registry study included 34,349 EC patients diagnosed between 2000 and 2020. Patients were classified into five risk groups. Overall survival was analyzed by Kaplan-Meier method as well as univariable and multivariable Cox regression to evaluate risk factors and treatment options., Results: Over the study period, minimal invasive surgery was used more often compared to open surgery and was associated with better overall survival. Patients with advanced EC were more likely to receive multimodal therapy. Patients with intermediate risk EC had a good prognosis upon surgery, which further improved when radiotherapy was added. High-risk patients showed poorer prognosis but clearly benefited from additional radiotherapy. Survival of elderly high-risk patients with a non-endometrioid histology was improved when chemotherapy was added to surgery and radiotherapy., Conclusion: Our study includes a large analysis of data from German clinical cancer registries on the care of endometrial cancer during two decades. We observed an increase of minimal invasive surgery. There is evidence that minimal invasive surgery is not inferior to open surgery. Adjuvant radio- and chemotherapy further improves survival depending on risk group and age., (© 2024. The Author(s).)
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- 2024
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24. Treatment in Certified Breast Cancer Centers Improves Chances of Survival of Patients with Breast Cancer: Evidence Based on Health Care Data from the WiZen Study.
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Schoffer O, Wimberger P, Gerken M, Bierbaum V, Bobeth C, Rößler M, Dröge P, Ruhnke T, Günster C, Kleihues-van Tol K, Link T, Scharl A, Inwald EC, Kast K, Papathemelis T, Ortmann O, Klinkhammer-Schalke M, and Schmitt J
- Abstract
Introduction: Certified breast cancer centers offer specific quality standards in terms of their structure, diagnostic and treatment approaches with regards to breast surgery, drug-based cancer therapy, radiotherapy, and psychosocial support. Such centers aim to improve treatment outcomes of breast cancer patients. The question investigated here was whether patients with primary breast cancer have a longer overall survival if they are treated in a certified breast cancer center compared to treatment outside these centers., Methods: We used patient-specific data (demographics, diagnoses, treatments) obtained from data held by mandatory health insurance companies ( gesetzliche Krankenversicherung , GKV) and clinical cancer registries (KKR) for the period 2009-2017 as well as hospital characteristics recorded in standardized quality reports. Using multivariable Cox regression analysis, we investigated differences in survival between patients treated in hospitals certified as breast cancers centers by the German Cancer Society (DKG) and patients treated in hospitals which had not been certified by the DKG., Results: The sample population consisted of 143720 (GKV data) and 59780 (KKR data) patients with breast cancer, who were treated in 1010 hospitals across Germany (280 DKG-certified, 730 not DKG-certified). 63.5% (GKV data) and 66.7% (KKR data) of patients, respectively, were treated in DKG-certified breast cancer centers. Cox regression analysis for overall survival which included patient and hospital characteristics found a significantly lower mortality risk for patients treated in DKG-certified breast cancer centers (GKV data: HR = 0.77, 95% CI = 0.74-0.81; KKR data: HR = 0.88, 95% CI = 0.85-0.92). This result remained stable even after several sensitivity analyses including stratified estimates for subgroups of patients and hospitals. The effect was even more pronounced for recurrence-free survival (KKR data: HR = 0.78, 95% CI = 0.74-0.82)., Conclusions: Patients who are treated by an interdisciplinary team in a DKG-certified breast cancer had clear and statistically significantly better survival rates. Certification is therefore an effective means of improving the quality of care, and more patients should be treated in certified breast cancer centers., Competing Interests: Conflict of Interest OS, VB, CB and JS work in a university hospital with certified cancer centers, and MR previously also worked there. In addition, they received grants from the Innovation Fund of the Federal Joint Committee when carrying out the study. Independently of this study, JS received institutional grants for investigator-initiated research from the G-BA, the BMG, BMBF, the EU, the German Federal State of Saxony, Novartis, Sanofi, ALK and Pfizer. He also took part in Advisory Board Meetings as a paid consultant for Sanofi, Lilly and the ALK. Independently of this study, OS was a paid consultant for Novartis. He is also a member of the certification committee “Skin Cancer Centers” of the German Cancer Society and a member of the panel of experts for the project “Research into criteria to evaluate certificates and quality seals in accordance with Sec. 137a para. 3 sentence 2 No. 7 SGB V” for the Institute for Quality Assurance and Transparency in Healthcare (IQTIG). PW heads the DKG-certified Breast and Gynecological Cancer Center at the university hospital of Dresden University of Technology and is an additional member of the Board of Directors of NCT Dresden. PW is receiving institutional grants for investigator-initiated research from the DFG, Krebshilfe, Sächsische Aufbaubank (SAB), Gynäko-Onkologische Forschungsstiftung, Amgen, AstraZeneca, MSD, Novartis, Pfizer, Roche, Clovis, GSK. PW receives honoraria as an Advisory Board member for Amgen, AstraZeneca, MSD, Novartis, Pfizer, Lilly, Roche, Teva, Eisai, Gilead, GSK and Daiichi Sankyo. AS is the speaker for the Certification Committee for Breast Cancer Centers of the DKG and for many years he was the director of gynecological hospitals with certified breast cancer centers. He has had no financially relevant cooperations with industry in the last 4 years. ECI and OO work in a certified breast cancer center, gynecological cancer center and oncological center. OO is a member of the Executive Board of the German Cancer Society, head of the University Cancer Center Regensburg and a member of the Board of Directors of CCC WERA. TL works in a certified breast and gynecological cancer center. TL has received honoraria (lectures/consultancy work/travel costs) from Novartis, Roche, Amgen, GSK, Pfizer, Gilead, Daiichi Sankyo, AstraZeneca, Lilly, Myriad, MSD and Esai. TP is head of a DKG-certified breast and gynecological cancer center. St. Marien Amberg Medical Center is also an oncology center according to the criteria of the DKG. The other authors state that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
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- 2024
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25. Guideline concordant therapy improves survival in high-grade endometrial cancer patients.
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Scharl S, Sprötge T, Gerken M, Scharl A, Ortmann O, Kölbl O, Klinkhammer-Schalke M, and Papathemelis T
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- Humans, Female, Retrospective Studies, Radiotherapy, Adjuvant, Neoplasm Staging, Endometrial Neoplasms drug therapy
- Abstract
Purpose: Data from randomized controlled trials in high-grade endometrial cancer are scarce due to its low prevalence. Therefore, guideline recommendations in this cancer subtype rely on relatively few randomized trials and data from retrospective studies. The aim of this study was to evaluate the benefits from guideline-concordant therapy in high-grade endometrial cancer in a real-world patient group., Methods: The effect of treatment according to German S3 guidelines and the former S2k guideline on overall survival (OS) and recurrence-free survival (RFS) was evaluated in a cohort of 293 high-grade endometrial cancer patients., Results: Treatment concordant with the S3 guideline significantly improved OS (HR 0.623, CI 0.420-0.923, p = 0.018) and RFS (HR 0.578, CI 0.387-0.863, p = 0.007). Treatment concordant with the S2k guideline did not result in a significantly higher OS (HR 0.783, CI 0.465-1.316, p = 0.335) or RFS (HR 0.741, CI 0.347-1.740, p = 0.242)., Conclusion: Therapy according to the German S3 guideline improved OS and RFS in univariate as well as multivariate analysis in this cohort of high-grade endometrial cancer patients., (© 2022. The Author(s).)
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- 2023
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26. Crossed fused renal ectopia during paraaortic lymphadenectomy for cervical cancer.
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Tsaousidis G, Zitzelsberger U, and Papathemelis T
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- Female, Humans, Lymph Node Excision adverse effects, Kidney surgery, Uterine Cervical Neoplasms surgery, Kidney Diseases surgery
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- 2023
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27. Risk factors and temporal patterns of recurrences in patients with vulvar cancer: implications for follow-up intervals and duration.
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Röhrmoser K, Ignatov A, Gerken M, Ortmann O, Klinkhammer-Schalke M, and Papathemelis T
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- Female, Humans, Aged, Aged, 80 and over, Retrospective Studies, Follow-Up Studies, Neoplasm Recurrence, Local epidemiology, Risk Factors, Vulvar Neoplasms therapy
- Abstract
Background: To date, information on risk factors and temporal patterns of recurrences in patients with vulvar cancer is sparse. Conclusive data for an optimal surveillance strategy are lacking., Methods: This multicenter, retrospective population-based register study included 1412 patients who have been treated from 2000 to 2017 for vulvar cancer in the German districts of Upper Palatinate, Lower Bavaria, and Saxony-Anhalt. Kaplan-Meier method, and univariate and multivariate Cox regression were employed to evaluate prognostic factors and temporal course of overall survival, cumulative recurrence, and recurrence-free survival rates., Results: After exclusion, the final study cohort comprised 829 patients. Most recurrences occurred within the first 3 years after diagnosis. Notably, a significant subset of patients were recurrent even after 5 years. The cumulative recurrence rate from all relapses was 18.6% 1 year after primary diagnosis. The recurrence rate increased to 34.7% after 3, to 41.8% after 5, and to 56.6% after 10 years post-diagnosis. The risk of relapse was significantly increased in patients over 70 years of age (hazard ratio (HR) = 2.7; p < 0.001; 95% CI 1.6-4.4), and in patients with positive nodal status N1 (HR = 2.0; p = 0.019; 95% CI 1.1-3.5) and N2/3 (HR = 2.2; p = 0.033; 95% CI 1.1-4.4)., Conclusion: Our study provides compelling evidence that follow-up care should be carried out for longer than 5 years, especially for high-risk patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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28. Survival Advantage of Lymphadenectomy in Patients with Ovarian Cancer.
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Ignatov A, Hassan SS, Ivros S, Papathemelis T, Ignatova Z, and Eggemann H
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- Carcinoma, Ovarian Epithelial surgery, Female, Humans, Neoplasm Staging, Pelvis pathology, Retrospective Studies, Lymph Node Excision, Ovarian Neoplasms pathology
- Abstract
We investigated the survival effect of lymphadenectomy in ovarian cancer. The five-year progression-free and overall survival in early-stage ovarian cancer were not affected. Preliminary, unadjusted analysis in advanced ovarian cancer suggested an improvement in survival. However, after adjusting for other factors, e.g. ECOG performance status and patients' age, this survival advantage vanished. Our analysis suggests that systemic pelvic and para-aortic lymphadenectomy was not associated with an improvement of the progression-free and overall survival of patients with optimally debulked ovarian cancer.
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- 2022
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29. The 3D in vivo chorioallantoic membrane model and its role in breast cancer research.
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Kohl C, Aung T, Haerteis S, Ignatov A, Ortmann O, and Papathemelis T
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- Animals, Cell Line, Tumor, Chorioallantoic Membrane metabolism, Chorioallantoic Membrane pathology, Female, Humans, Neovascularization, Pathologic pathology, Antineoplastic Agents therapeutic use, Breast Neoplasms pathology
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Purpose: We aimed to evaluate the role of the chorioallantoic membrane model (CAM) in breast cancer research., Methods: The following is an overview of the use of the CAM in the field of breast cancer research based on a PubMed literature query., Results: The CAM is a 3D in vivo model that can be used for the analysis of tumor growth, biology and angiogenesis of primary tumor tissue or tumor cell lines. The CAM model has been used in breast cancer research for drug testing, migration assays and the evaluation of vascularization, amongst others. The CAM model is a valuable method that offers a better imitation of the physiological phenomena compared to 2D or 3D in vitro models., Conclusion: The CAM model has primarily and successfully been utilized for the assessment of the tumor biology of established breast cancer cell lines. Further, the CAM model is a promising method to analyze patient derived primary tumor material and could be used as a "patient-specific 3D-tumor-therapy-model" for the cost-efficient evaluation of anti-cancer drugs to find the optimal treatment for breast cancer patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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30. Factors influencing treatment decision and guideline conformity in high-grade endometrial cancer patients: a population-based study.
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Scharl S, Sprötge T, Gerken M, Scharl A, Ignatov A, Inwald EC, Ortmann O, Kölbl O, Klinkhammer-Schalke M, and Papathemelis T
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- Female, Humans, Neoplasm Staging, Radiotherapy, Adjuvant, Retrospective Studies, Carcinosarcoma pathology, Endometrial Neoplasms pathology
- Abstract
Purpose: Treatment according to guidelines has been demonstrated to improve survival in a number of different cancer entities. Deviations from guidelines depend on several factors, including the patient's preferences, age and comorbidities. The aim of this study was to assess the adherence to guideline recommendations concerning surgical and adjuvant treatment in endometrial cancer. Furthermore, we sought to evaluate the reasons for non-adherence to guidelines by further examining the influence of comorbidities and age., Methods: The influence of age, comorbidities, tumor stage and histological subtype on guideline adherence was evaluated by multivariable logistic regression in a cohort of 353 high-grade endometrial cancer patients. High-grade endometrial cancer was defined as carcinosarcoma, Type II (serous, clear cell, mixed cell carcinoma) and Type I G3 histology., Results: Extensive surgical procedures, particularly systematic LNE, were less frequently applied in patients with comorbidities (p = 0.015) or higher age (p < 0.01). Guideline adherence was not affected by comorbidities (p = 0.563), but was significantly reduced with higher age (p < 0.01). In a multivariable model, higher age (p < 0.01), obesity (p = 0.011), higher FIGO Stage (p < 0.01) and histologic subtype (p < 0.01) significantly decreased OS. Surgery (p < 0.001), chemotherapy (p < 0.01) and systematic LNE (p = 0.011) were associated with higher OS., Conclusion: Age seems to be the strongest independent factor leading to guideline deviation. Comorbidities were associated with less aggressive treatment, but not with deviations from guidelines., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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31. Preclinical safety testing and initial experience of a morcellation bag with four sealable ports.
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Anapolski M, Schellenberger A, Alkatout I, Panayotopoulos D, Gut A, Soltesz S, Schiermeier S, Papathemelis T, and Noé GK
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- Female, Humans, Hysterectomy methods, Laparoscopy methods, Leiomyoma surgery, Surgical Instruments adverse effects, Uterus surgery, Morcellation adverse effects, Morcellation methods
- Abstract
Electromechanical morcellation-so called power morcellation-is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11-24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4-14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20-194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13-896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0-39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies., (© 2021. The Author(s).)
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- 2021
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32. Is there a benefit for adjuvant radio(chemo)therapy in early cervical cancer? Results from a population-based study.
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Scharl S, Becher C, Gerken M, Scharl A, Anapolski M, Ignatov A, Inwald EC, Ortmann O, Kölbl O, Klinkhammer-Schalke M, and Papathemelis T
- Subjects
- Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Female, Humans, Kaplan-Meier Estimate, Middle Aged, Neoplasm Staging, Radiotherapy Dosage, Radiotherapy, Adjuvant, Survival Rate, Treatment Outcome, Uterine Cervical Neoplasms mortality, Uterine Cervical Neoplasms pathology, Antineoplastic Agents therapeutic use, Combined Modality Therapy methods, Uterine Cervical Neoplasms drug therapy, Uterine Cervical Neoplasms radiotherapy
- Abstract
Purpose: Due to insufficient and conflicting prospective evidence, the recommendations on when to apply adjuvant radiochemotherapy in early-stage cervical cancer vary between international guidelines. In this population-based study, we evaluated the outcome of patients with early-stage cervical cancer based on risk factors and the adjuvant therapy they received., Methods: The effect of primary therapy (surgery and radiochemotherapy RCT, surgery and radiotherapy RT, and surgery alone) on overall survival (OS) and recurrence-free survival (RFS) was evaluated in the complete cohort of 442 patients and in subgroups according to risk profile and nodal status., Results: In low-risk patients, there was no difference in OS (p = 0.276) depending on whether patients received adjuvant therapy or not. Concerning RFS, patients with RT (including one patient with RCT) exhibited a significantly worse outcome compared to the group with surgery alone (p = 0.015). In intermediate-risk patients, the administration of adjuvant RT significantly benefited RFS when compared to surgery only in multivariate analysis (p = 0.031). Concerning OS, no significant influence for adjuvant treatment could be seen (p = 0.354). Though trends towards better OS and RFS could be observed in patients of the high-risk group-both in RCT and RT groups compared to surgery alone-the effects did not prove to be significant., Conclusion: Our study reaffirms the evidence against the use of adjuvant radio(chemo)therapy in low-risk early-stage cervical cancer. In intermediate-, and less pronounced in high-risk patients, however, it seems to be beneficial. The role of adjuvant radio(chemo)therapy in early cervical cancer should be further investigated in prospective randomized trials., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)
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- 2021
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33. Endometrial Cancer Lymphadenectomy Trial (ECLAT) (pelvic and para-aortic lymphadenectomy in patients with stage I or II endometrial cancer with high risk of recurrence; AGO-OP.6).
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Emons G, Kim JW, Weide K, de Gregorio N, Wimberger P, Trillsch F, Gabriel B, Denschlag D, Kommoss S, Aydogdu M, Papathemelis T, Gropp-Meier M, Muallem MZ, Kühn C, Müller A, Frank M, Weigel M, Bronger H, Lampe B, Rau J, Schade-Brittinger C, and Harter P
- Subjects
- Female, Humans, Neoplasm Recurrence, Local, Neoplasm Staging, Risk Factors, Treatment Outcome, Endometrial Neoplasms surgery, Lymph Node Excision methods
- Abstract
Background: The impact of comprehensive pelvic and para-aortic lymphadenectomy on survival in patients with stage I or II endometrial cancer with a high risk of recurrence is not reliably documented. The side effects of this procedure, including lymphedema and lymph cysts, are evident., Primary Objective: Evaluation of the effect of comprehensive pelvic and para-aortic lymphadenectomy in the absence of bulky nodes on 5 year overall survival of patients with endometrial cancer (International Federation of Gynecology and Obstetrics (FIGO) stages I and II) and a high risk of recurrence., Study Hypothesis: Comprehensive pelvic and para-aortic lymphadenectomy will increase 5 year overall survival from 75% (no lymphadenectomy) to 83%, corresponding to a hazard ratio of 0.65., Trial Design: Open label, randomized, controlled trial. In arm A, a total hysterectomy plus bilateral salpingo-oophorectomy is performed. In arm B, in addition, a systematic pelvic and para-aortic lymphadenectomy up to the level of the left renal vein is performed. For all patients, vaginal brachytherapy and adjuvant chemotherapy (carboplatin/paclitaxel) are recommended., Major Inclusion Criteria: Patients with histologically confirmed endometrial cancer stages pT1b-pT2, all histological subtypes, and pT1a endometrioid G3, serous, clear cell, or carcinosarcomas can be included when bulky nodes are absent. When hysterectomy has already been performed (eg, for presumed low risk endometrial cancer), study participation is also possible., Exclusion Criteria: Patients with pT1a, G1 or 2 of type 1 histology or uterine sarcomas (except for carcinosarcomas), endometrial cancers of FIGO stage III or IV (except for microscopic lymph node metastases) or visual extrauterine disease., Primary Endpoint: Overall survival calculated from the date of randomization until death., Sample Size: 640 patients will be enrolled in the study., Estimated Dates for Completing Accrual and Presenting Results: At present, 252 patients have been recruited. Based on this, accrual should be completed in 2025. Results should be presented in 2031., Trial Registration: NCT03438474., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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34. Comparison of survival outcomes and effects of therapy between subtypes of high-grade endometrial cancer - a population-based study.
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Scharl S, Gerken M, Sprötge T, Kronberger K, Scharl A, Ignatov A, Ortmann O, Kölbl O, Klinkhammer-Schalke M, and Papathemelis T
- Subjects
- Female, Humans, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Retrospective Studies, Carcinoma, Endometrioid pathology, Endometrial Neoplasms pathology, Endometrial Neoplasms therapy
- Abstract
Background: Similarities in outcome between grade 3 endometrioid cancer and non-endometrioid histologies have been reported by a number of studies. Other reports, however, stated a significantly better prognosis for G3 endometrioid compared to type II histology. In this population-based study, we compared the outcome and treatment approaches of high-grade endometrial cancer patients with FIGO stages I-III depending on their histology., Material and Methods: 284 high-grade endometrial cancer patients diagnosed between 1998 and 2015 were retrospectively analyzed. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared depending on histology., Results: Type I G3 patients had a statistically significant OS advantage over women suffering from type II carcinoma (HR 1.527, 95%-CI 1.024-2.276; p = 0.038) and carcinosarcoma (HR 2.106, 95%-CI 1.270-3.493; p = 0.004) in univariable and multivariable Cox-regression analysis. RFS in Type I G3 was significantly superior compared to patients with carcinosarcoma (HR 1.719, 95%-CI 1.018-2.901; p = 0.043) and not significantly superior to type II patients (HR 1.368, 95%-CI 0.920-2.036; p = 0.122). Cumulative recurrence rates were significantly higher in carcinosarcoma compared to type I G3 (HR 2.217, 95%-CI 1.096-4.485; p = 0.027) in univariable analysis, but not after risk adjustment (HR of 1.472, 95%-CI 0.654-3.311; p = 0.350)., Conclusion: The prognosis of patients with type I G3 endometrial cancer patients seems to be significantly superior to patients with type II cancer and particularly carcinosarcoma. Systematic LND seemed to be beneficial in all of the three subtypes. The benefit of adjuvant treatment methods may differ between histologies.
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- 2021
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35. Sentinel lymph node detection by means of indocyanine green using the Karl Storz VITOM ® fluorescence camera: a comparison between primary sentinel lymph node biopsy versus sentinel lymph node biopsy after neoadjuvant chemotherapy.
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Staubach P, Scharl A, Ignatov A, Ortmann O, Inwald EC, Hildebrandt T, Gerken M, Klinkhammer-Schalke M, Scharl S, and Papathemelis T
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms drug therapy, Coloring Agents analysis, Coloring Agents pharmacokinetics, Diagnostic Imaging instrumentation, Diagnostic Imaging methods, Female, Fluorescence, Humans, Indocyanine Green analysis, Indocyanine Green pharmacokinetics, Lymphatic Metastasis, Middle Aged, Neoadjuvant Therapy, Optical Imaging instrumentation, Optical Imaging methods, Predictive Value of Tests, Retrospective Studies, Sentinel Lymph Node metabolism, Sentinel Lymph Node pathology, Technetium analysis, Technetium pharmacokinetics, Antineoplastic Combined Chemotherapy Protocols pharmacology, Breast Neoplasms pathology, Sentinel Lymph Node diagnostic imaging, Sentinel Lymph Node drug effects, Sentinel Lymph Node Biopsy instrumentation, Sentinel Lymph Node Biopsy methods
- Abstract
Purpose: The usage of radioactive Technetium
99m (Tc99m ) colloid for the purpose of sentinel lymph node biopsy (SLNB) in early breast cancer is considered the gold standard in Germany. However, new tracers, such as near-infrared (NIR) imaging agents like indocyanine green (ICG) could offer an alternative in future, as they overcome drawbacks associated with radioactive Technetium99m (Tc99m ) like limited availability, high costs and radioactivity exposure for both patients and surgeons., Methods: In this double-arm retrospective study, we sought to establish the usefulness of indocyanine green as an alternative or an addition to the conventional Technetium99m (Tc99m ) in the identification of the SLN in early breast cancer., Results: Among the 161 patients who underwent primary SLNB, 34 patients had at least 1 SLN with metastasis. Among these patients with SLN metastasis, 33 had the SLN detected by ICG; while 31 had the SLN detected by Tc99m . The conventional Technetium99m radiotracer failed to detect 2 patients with metastasis in this Arm of the study. Among the 87 patients who underwent SLNB after NACT, 13 patients had at least 1 SLN with metastasis. Among these 13 patients with SLN metastasis, ICG and Tc99m had detected the SLN among 12 patients, while 1 patient had been detected by ICG alone., Conclusions: Our results show that ICG is as effective as the radioisotope for SLNB even among patients who have undergone NACT. This trial is registered with the German Clinical Trial Register, ID: DRKS00013606.- Published
- 2021
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36. Laparoscopic approaches to the retropubic space: three alternatives with anatomical considerations.
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Anapolski M, Alkatout I, Wedel T, Panayotopoulos D, Soltesz S, Schiermeier S, Papathemelis T, and Noé GK
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- Humans, Surgical Instruments, Laparoscopy, Urinary Incontinence, Stress surgery
- Abstract
Introduction: Many urogynecological and surgical laparoscopic interventions require access to the retropubic space, also known as the space of Retzius. Especially in patients with a history of previous surgery in this area or in general in the lower abdomen, the preparation may be complicated by adhesions and scar tissue. The necessity to combine several laparoscopic procedures in one surgical session may require consideration of the most appropriate way to approach the retropubic space., Material and Methods: We describe and discuss three different options to access the space of Retzius via laparoscopy: the medial transperitoneal, the extraperitoneal and the lateral transperitoneal approach. For all approaches, we used one umbilical trocar and two trocars in the lower abdomen., Results: An algorithm was developed to select the most appropriate access route to the retropubic space, depending on the history of previous surgeries and accompanying interventions., Conclusion: The knowledge of different access routes to the retropubic space offers the possibility of adjusting the surgical procedure to the individual constellation of the patient.
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- 2021
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37. Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020).
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Burghaus S, Schäfer SD, Beckmann MW, Brandes I, Brünahl C, Chvatal R, Drahoňovský J, Dudek W, Ebert AD, Fahlbusch C, Fehm T, Fehr PM, Hack CC, Häuser W, Hancke K, Heinecke V, Horn LC, Houbois C, Klapp C, Kramer H, Krentel H, Langrehr J, Matuschewski H, Mayer I, Mechsner S, Müller A, Müller A, Müller M, Oppelt P, Papathemelis T, Renner SP, Schmidt D, Schüring A, Schweppe KW, Seeber B, Siedentopf F, Sirbu H, Soeffge D, Weidner K, Zraik I, and Ulrich UA
- Abstract
Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature. Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG. Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed., Competing Interests: Conflict of Interest/Interessenkonflikt The conflicts of interests of the authors are listed in the long version of the guideline./Die Interessenkonflikte der Autoren sind in der Langfassung der Leitlinie aufgelistet., (Thieme. All rights reserved.)
- Published
- 2021
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38. Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair.
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Noé GK, Schiermeier S, Papathemelis T, Fuellers U, Khudyakovd A, Altmann HH, Borowski S, Morawski PP, Gantert M, De Vree B, Tkacz Z, Ugarteburu RG, and Anapolski M
- Abstract
Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210-5.). The short-term follow-up of this international multicenter study carried out now is presented in this article., Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12-18 months., Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period., Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.
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- 2021
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39. Assessment of breast cancer primary tumor material in a 3D in vivo model.
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Kohl C, Aung T, Haerteis S, and Papathemelis T
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- Animals, Chickens, Chorioallantoic Membrane, Female, Humans, Breast Neoplasms
- Abstract
Background: Breast cancer is the most common malignant tumor in women and highly heterogeneous with a variety of different molecular subtypes. The analysis of the individual tumor biology is necessary to develop a specific and individualized treatment plan for every patient. The chick chorioallantoic membrane (CAM) model, a 3D-in-vivo-tumor-model, could potentially provide a methodology that facilitates the gain of additional information regarding the tumor biology as well as the testing of the tumor's individual sensitivity to different therapies., Objective: The objective was to establish the grafting of different breast cancer primaries onto the CAM for tumor profiling and the investigation of different parameters., Methods: Breast cancer primary tissue of different patients was grafted onto the CAM. Subsequently, 3D volume and perfusion measurements were performed during the engraftment period. Histological analyses of the tumors were carried out after the engraftment period., Results: The grafting of the breast cancer primaries onto the CAM was successful. The tumors remained partially vital and displayed angiogenic development on the CAM., Conclusions: Breast cancer primary material can be grafted onto the CAM and we observed visible and measurable changes of perfusion over time.
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- 2021
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40. Comparison of survival of patients with endometrial cancer undergoing sentinel node biopsy alone or systematic lymphadenectomy.
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Ignatov A, Papathemelis T, Ivros S, Ignatov T, Ortmann O, and Eggemann H
- Subjects
- Adult, Aged, Aged, 80 and over, Cohort Studies, Endometrial Neoplasms mortality, Endometrial Neoplasms pathology, Female, Humans, Middle Aged, Prospective Studies, Retrospective Studies, Survival Analysis, Endometrial Neoplasms secondary, Lymph Node Excision methods, Sentinel Lymph Node surgery, Sentinel Lymph Node Biopsy methods
- Abstract
Background: Recently, sentinel lymph node mapping was introduced in the surgical staging of endometrial cancer as alternative to systematic lymphadenectomy. However, the survival impact of sentinel node mapping is not well characterized yet., Methods: We performed retrospective study of 104 patients with endometrial cancer treated with sentinel lymph node alone (n = 52) or with pelvic and para-aortic lymphadenectomy (n = 52). For sentinel node mapping, indocyanine green was used. The outcome measure was disease-free survival., Results: Median follow-up was 42 months. Fifty-two patients staged by sentinel lymph node mapping were matched in 1:1 ratio with 52 patients staged by lymphadenectomy using patient age, histological type, tumor stage, tumor grade and lymph and vascular space invasion as matching criteria. The median number of removed lymph node was 3 (range 1-6) and 36 (13-63) in the sentinel and lymphadenectomy group, respectively. The rate of lymph node metastases was not significantly higher in the sentinel group (19.2%) in comparison with the lymphadenectomy group (14.3%). The overall detection rate of sentinel lymph nodes was 100% with a bilateral mapping of 98.1%. Most of the 152 lymph nodes identified and removed were localized in upper paracervical pathway (n = 143, 94.1%). During the follow-up period, overall 21 (20.2%) events were observed, 8 (15.4%) in the sentinel group and 13 (25.0%) in the lymphadenectomy group. The estimated disease-free survival was 84.6% and 75.0% for patients in the sentinel and lymphadenectomy groups, respectively. The survival curves demonstrated similar disease-free survival in two groups (p = 0.774)., Conclusion: Sentinel lymph node mapping did not compromise the outcome of patients with endometrial cancer.
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- 2020
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41. Systematic lymphadenectomy in early stage endometrial cancer.
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Ignatov A, Ivros S, Bozukova M, Papathemelis T, Ortmann O, and Eggemann H
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- Aged, Endometrial Neoplasms pathology, Female, Humans, Neoplasm Staging, Endometrial Neoplasms surgery, Lymph Node Excision methods
- Abstract
Background: The positive effect of systematic lymphadenectomy on survival of patients with endometrial cancer is a topic of ongoing debate., Methods: We aimed to investigate whether systemic lymphadenectomy is beneficial for patients with early endometrial cancer. For this purpose, we analyzed a population-based registry with of 2392 women with endometrioid endometrial cancer, stage I and II at intermediate and high risk of recurrence. The primary outcome measure was overall survival., Results: After exclusions, 868 women were eligible for analysis. Of those, 511 and 357 were categorized as intermediate (pT1A G3 and pT1B G1-2) and high risk (pT1B G3 and pT2 G1-3) early stage endometrial cancer, respectively. Lymphadenectomy was performed in 527 (60.7%) of the cases. Patients in the lymphadenectomy group were significantly younger, presented with more tumors of intermediate or undifferentiated grade and exhibited significantly lower co-morbidity rates and Eastern Cooperative of Oncology Group (ECOG) performance status. Median follow-up was 6.7 years. Recurrence-free survival was not improved by lymphadenectomy in the intermediate and high-risk group of patients. During the follow-up period, 111 (12.8%) women had disease recurrence and 302 (34.8%) died. Systematic lymphadenectomy was associated with significant improvement of overall survival in the pT1A G3 and pT1B G3 patient subgroups. Notably, adjustment for patient age and ECOG status abolished the improvement of overall survival by systematic lymphadenectomy in all groups. Thus, lymphadenectomy did not improve recurrence-free survival in the intermediate risk or the high-risk group of patients CONCLUSIONS: Systematic pelvic and para-aortic lymphadenectomy did not improve the survival of patients with early stage I and II endometrioid endometrial cancer at intermediate and high risk of recurrence.
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- 2020
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42. Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure.
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Papathemelis T, Oppermann H, Grafl S, Gerken M, Pauer A, Scharl S, Scharl A, Inwald E, Ignatov A, Ortmann O, Klinkhammer-Schalke M, Hein A, Beckmann MW, and Lux MP
- Subjects
- Aged, Cohort Studies, Disease-Free Survival, Endometrial Neoplasms pathology, Female, Humans, Kaplan-Meier Estimate, Laparoscopy methods, Laparoscopy statistics & numerical data, Lymph Node Excision statistics & numerical data, Lymph Nodes pathology, Middle Aged, Neoplasm Staging, Propensity Score, Proportional Hazards Models, Retrospective Studies, Treatment Outcome, Endometrial Neoplasms surgery, Lymph Node Excision methods, Lymph Nodes surgery
- Abstract
Objective: The primary therapy for intermediate- and high-risk endometrial cancer includes pelvic and paraaortic lymph node evaluation. Laparoscopic surgery is an increasingly popular intervention due to decreased risk and better short-term morbidity; however, a recent study casts doubt on the benefit of this approach in terms of oncological safety. In this cancer registry study, we sought to evaluate the benefit of laparoscopy versus laparotomy and retrospectively compared overall survival, recurrence rates, and recurrence-free survival among patients with intermediate- and high-risk endometrial cancer who underwent either laparoscopic or open surgery., Methods: This observational study included 419 patients who have been treated from 2011 to 2017. We employed Kaplan-Meier method, and univariable and multivariable Cox-regression to compare overall survival, recurrence rates, and recurrence-free survival in 110 patients, who underwent laparoscopic, with 309 patients, who underwent open surgery. To address the confounding bias in this retrospective study, we also performed a propensity score matching (PSM) analysis including 357 patients (laparoscopy: n = 107; open surgery: n = 250)., Results: We found a benefit for laparoscopic over open surgery in patients with intermediate- and high-risk endometrial cancer for overall survival in both univariable (p = 0.002; PSM: p = 0.016) and multivariable analyses (p = 0.019; PSM: p = 0.007). In contrast, there was no statistically significant difference between both patient groups regarding the cumulative recurrence rates. A univariable analysis identified a significant benefit for laparoscopy regarding recurrence-free survival (p = 0.003; PSM: p = 0.029) but a multivariable analysis failed to confirm this finding (p = 0.108; PSM: p = 0.118)., Conclusions: Our study provides evidence that laparoscopic systematic lymphadenectomy does not present a lower oncological efficacy than open surgery in the treatment of patients with endometrial cancer.
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- 2020
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43. Value of indocyanine green pelvic lymph node mapping in the surgical approach of cervical cancer.
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Papathemelis T, Scharl A, Anapolski M, C Inwald E, Ignatov A, Ortmann O, Gerken M, Klinkhammer-Schalke M, and Scharl S
- Subjects
- Adult, Aged, Female, Humans, Indocyanine Green pharmacology, Middle Aged, Retrospective Studies, Uterine Cervical Neoplasms pathology, Indocyanine Green therapeutic use, Sentinel Lymph Node diagnostic imaging, Sentinel Lymph Node Biopsy methods, Uterine Cervical Neoplasms surgery
- Abstract
Purpose: Lymph node metastasis is a significant predictive factor for disease recurrence and survival in cervical cancer patients and relevant for therapeutic strategies. We evaluated the clinical value of indocyanine green (ICG) by measuring the sensitivity and negative predictive value of sentinel lymph node mapping compared with the gold standard of complete lymphadenectomy in detecting lymph node metastases for cervical cancer., Methods: We utilized the near-infrared imaging agent ICG to detect tumor-infested lymph nodes in the pelvis analogue to a classical sentinel lymph node procedure by analyzing data from 20 patients who had undergone surgery for cervical cancer at our institution. A laparoscopic lymph node mapping procedure by means of ICG, followed by a complete pelvic lymphadenectomy with or without paraaortic lymphadenectomy was done in all patients., Results: Histological examination identified seven patients with tumor-positive pelvic nodes, whereas mapping with ICG identified only five of these patients. Detection rate of positive nodes by ICG mapping and false negative rate was 71.4% and 28.6%, respectively; bilateral detection rate was 83.3%. One of the two false negative patients additionally suffered from deep infiltrating endometriosis., Conclusions: Our results indicate that ICG can identify the relevant pelvic nodes independent of tumor size, provided bilateral detection is achieved and additional, related diseases are excluded., Trial Registration: This trial is registered within the German Clinical Trial Register (DRKS-ID: DRKS00014692).
- Published
- 2020
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44. Prospective international multicenter pectopexy trial: Interim results and findings post surgery.
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Noé GK, Schiermeier S, Papathemelis T, Fuellers U, Khudyakov A, Altmann HH, Borowski S, Morawski PP, Gantert M, De Vree B, Zbigniew T, Ugarteburu RG, and Anapolski M
- Subjects
- Europe epidemiology, Female, Humans, Operative Time, Postoperative Complications epidemiology, Prospective Studies, Gynecologic Surgical Procedures statistics & numerical data, Pelvic Organ Prolapse surgery
- Abstract
The technique of laparoscopic pectopexy was published in 2010. A subsequent randomized trial focused on pectopexy versus sacropexy revealed no new risks for patients and significant advantages in terms of operating time and de novo defecation disorders compared to sacrocolpopexy. The present international multicenter trial was performed to evaluate the applicability of the technique in clinical routine., Material and Method: Eleven clinics and 13 surgeons in four European counties participated in the trial. To ensure a standardized approach and obtain comparable data, all surgeons followed the same rules in placing the apical tape, no further mesh was used. Data were collected for 14 months on a secured server; 501 surgeries were documented and evaluated., Results: Patients treated at the leading center (2 surgeons) contributed 44 % of the patient population. We made a distinction between high-volume (48-135 surgeries annually) (n = 4), intermediate-volume (28-37 surgeries annually) (n = 4), and low-volume (7-22 surgeries annually) (n = 5) surgeons. 97.3 % of the patients (n = 501) had delivered children; 5.6 % had had a Caesarian section. 29.7 % of the patients had undergone a hysterectomy. The operating time for pectopexy was less than 60 min in 79 % of cases. The procedures were completed in less than 159 min in 71 % of cases. Severe complications (n = 5) included four cases of organ damage (related to concomitant surgeries or adhesions) and one case of relevant bleeding. De novo incontinence was registered in two cases and voiding dysfunction in three. No intestinal obstruction or defecation disorder was observed. Two complicated infections were noted. Urinary infection occurred in 2 % of patients., Conclusion: In clinical routine severe complications occurred in 1 %. The latter were unrelated to pectopexy, but occurred due to concomitant procedures or adhesions. The overall operating time as well as the operating time for pectopexy were similar to those reported in published studies on sacrocolpopexy., (Copyright © 2019 Elsevier B.V. All rights reserved.)
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- 2020
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45. Lymph node micrometastases and outcome of endometrial cancer.
- Author
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Ignatov A, Lebius C, Ignatov T, Ivros S, Knueppel R, Papathemelis T, Ortmann O, and Eggemann H
- Subjects
- Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Cohort Studies, Disease-Free Survival, Endometrial Hyperplasia therapy, Female, Germany epidemiology, Humans, Lymphatic Metastasis, Middle Aged, Neoplasm Micrometastasis, Radiotherapy, Adjuvant, Registries, Retrospective Studies, Endometrial Hyperplasia mortality, Endometrial Hyperplasia pathology, Lymph Nodes pathology
- Abstract
Background: The relationship between nodal micrometastases and clinical outcome of endometrial cancer is unclear., Patients and Methods: We performed a multicenter, retrospective registry-based study of 2392 patients with endometrial cancer with and without nodal micrometastases. The primary outcome measure was disease-free survival., Results: After exclusions, the final study involved 428 patients: 302 (70.6%) with node-negative endometrial cancer, who did not receive adjuvant treatment, 95 (22.2%) with nodal micrometastases who received adjuvant treatment, and 31 (7.2%) with nodal micrometastases who did not receive adjuvant treatment. The median follow-up was 84.8 months. Without adjuvant therapy the disease-free survival in the cohort of patients with micrometastases was significantly reduced as compared with disease-free survival in the node-negative cohort (p = 0.0001). With adjuvant therapy the median disease-free survival of patients with nodal micrometastases was similar with those of node-negative patients (p = 0.648). The adjusted hazard ratio for disease events among patients with micrometastases and no adjuvant therapy, as compared with node-negative patients, was 2.23 (95% confidence interval [CI] 1.26-3.95). In the cohort with micrometastases the relative risk of events was significantly decreased by adjuvant therapy (HR 0.29, 95%CI 0.13-0.65) even after adjustment for age at diagnosis, myometrial invasion, histological grade and type, and performance status., Conclusions: Nodal micrometastases are associated with decreased disease-free survival of patients with endometrial cancer. Adjuvant therapy was associated with improved disease-free survival of patients with micrometastases., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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46. Laparoscopic Removal of a Dislocated Screw of a Hip Joint Endoprosthesis during Oncologic Surgery.
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Halder C, Hauzenberger T, Scharl A, Bauer R, and Papathemelis T
- Published
- 2019
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47. Impact of nodal status and treatment strategy on overall survival in advanced stage cervical cancer.
- Author
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Papathemelis T, Knobloch S, Gerken M, Scharl A, Anapolski M, Ignatov A, Inwald EC, Ortmann O, Scharl S, and Klinkhammer-Schalke M
- Subjects
- Adult, Aged, Aged, 80 and over, Combined Modality Therapy methods, Comorbidity, Female, Humans, Kaplan-Meier Estimate, Lymph Node Excision, Lymphatic Metastasis, Middle Aged, Neoplasm Staging, Retrospective Studies, Uterine Cervical Neoplasms therapy, Young Adult, Lymph Nodes pathology, Uterine Cervical Neoplasms mortality, Uterine Cervical Neoplasms pathology
- Abstract
Purpose: The lack of prognostic data impedes implementation of optimal therapy for cervical cancer. For instance, recommended therapy for FIGO IIB cervical cancer is radical hysterectomy or radiochemotherapy. To enlighten different therapeutic approaches, we investigated the benefit of individual therapies or combination thereof in patients with or without infested lymph nodes., Methods: The German Tumor Centre Regensburg registered 389 patients with FIGO IIB, IIIA, IIIB, and IVA cervical cancer between 2002 and 2015. We estimated hazard ratios (HR) for overall survival against different therapies using univariable and multivariable cox regression. After risk adjustment with respect to clinicopathological parameters, we performed model selection using conditional stepwise reverse selection., Results: We demonstrated the need for thorough assessment of the nodal status to obtain reliable data for treatment strategy. Our analysis showed significant differences for overall survival in FIGO IIB depending on therapy and nodal status. Outcome was inferior with radiochemotherapy without surgery for patients with N0 compared to surgery and radiochemotherapy combined (HR 3.012; 95% CI 1.075-8.441; p = 0.036); however, for N1, radiochemotherapy without surgery resulted in comparable outcome (HR 0.808; 95% CI 0.189-3.403; p = 0.765), whereas surgery alone yielded in poor outcome (HR 2.889; 95% CI 1.356-6.156; p = 0.006). Regardless of the nodal status, chemotherapy was superior in advanced stage cervical cancer FIGO III to IVA., Conclusions: Our study suggests that in terms of oncological outcome FIGO IIB cervical cancer patients benefit from a combination of surgery and radiochemotherapy. However, in the presence of lymph node infestation, surgery does not add substantial benefit to the patient.
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- 2019
- Full Text
- View/download PDF
48. Quality of life and oncological outcome in endometrial cancer patients after vaginal brachytherapy: comparison of two dosing schemes.
- Author
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Papathemelis T, Scharl S, Hipp M, Scharl A, Beckmann MW, Lux MP, and Kölbl O
- Subjects
- Aged, Endometrial Neoplasms pathology, Endometrial Neoplasms psychology, Female, Humans, Prospective Studies, Retrospective Studies, Vagina pathology, Brachytherapy methods, Endometrial Neoplasms radiotherapy, Quality of Life psychology, Vagina radiation effects
- Abstract
Purpose: Vaginal brachytherapy reduces the risk of local recurrence and was shown to be equieffective in preventing vaginal vault recurrence, but less toxic compared to external-beam radiotherapy in a subset of high intermediate-risk endometrial cancer patients and is administered as single adjuvant treatment in those patients. Different radiotherapeutic approaches with various dosing schemes exist toward brachytherapy. The aim of this study was to compare the outcome and long-term quality of life after brachytherapy with two different high-dose-rate dosing schemes., Methods: Retrospective analysis was conducted of the recurrence and survival rates of 104 patients with endometrial cancer FIGO stage I-II that underwent adjuvant brachytherapy with three times 5 Gy or four times 5 Gy to the upper two-thirds of the vaginal vault in two different institutions between January 2010 and December 2013. Quality of life was assessed by EORTC QLQ-30 questionnaire and EN 24 module., Results: The vaginal vault recurrence rates were 4.9% and 5.0% for patients treated with 3 × 5 Gy and 4 × 5 Gy, respectively (p = 0.98). We did not observe a difference in pelvic recurrence (p = 0.96), overall survival (p = 0.33) or quality of life between the different radiotherapy regimens. Metastatic recurrence and the use of chemotherapy contribute to impairment on quality of life. Younger patients (< 70 years) reported worse emotional functioning (p = 0.02) and higher symptom scales of diarrhea (p = 0.01) and financial problems (p = 0.03). Sexual activity was lower in patients younger than 70 years (p = 0.05)., Conclusions: Further prospective studies are needed to evaluate the effect of dosing schemes on recurrence rates and quality of life. Younger patients (< 70 years) seem to experience greater reduction in quality of life due to endometrial cancer diagnosis.
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- 2019
- Full Text
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49. Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis.
- Author
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Papathemelis T, Hassas D, Gerken M, Klinkhammer-Schalke M, Scharl A, Lux MP, Beckmann MW, and Scharl S
- Subjects
- Aged, Aged, 80 and over, Endometrial Neoplasms surgery, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Retrospective Studies, Survival Rate, Endometrial Neoplasms mortality, Endometrial Neoplasms pathology, Lymph Node Excision mortality, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology
- Abstract
Purpose: The recommended therapy for type I FIGO IB endometrial cancer (EC) is hysterectomy and adnexectomy, but the therapeutic benefits of additional pelvic and paraaortic lymph node dissection (LND) are still under discussion. In this study, we retrospectively evaluated overall survival (OAS) and recurrence-free survival (RFS) among patients with type I FIGO IB EC who did undergo systematic or elective lymphadenectomy or none at all., Methods: We selected 299 individuals from the database of the German Tumor Centre Regensburg who were diagnosed between 1998 and 2015 with endometrial adenocarcinoma of the uterus type I FIGO IB. We applied multivariable Cox regression to the selected patient data and estimated hazard ratios for OAS and RFS against the performed intervention. Further, we carried out risk adjustments with respect to clinicopathological parameters, and performed model selection using conditional stepwise forward selection., Results: We observed significant benefits of LND in the unadjusted survival analysis; however, we did not confirm this effect in multivariable regression analysis upon risk adjustment. In this case, hazard ratio (HR) for OAS in patients without LND versus patients with LND is reduced to 1.214 (95% CI 0.771-1.911; p = 0.402), HR for RFS is 1.059 (95% CI 0.689-1.626; p = 0.795). Similarly, we were also able to eliminate the statistical benefit of systematic versus elective LND by risk adjustment., Conclusions: In contrast to previous observations in high-grade EC, our study provides compelling evidence that LND, in particular systematic lymphadenectomy, is not beneficial for patients with type I FIGO IB EC in terms of long-term OAS and RFS.
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- 2018
- Full Text
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50. Does post-operative radiochemotherapy improve survival in high-grade endometrial cancer patients? Results of a population-based cohort analysis of a cancer registry.
- Author
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Scharl S, Papathemelis T, Kronberger K, Gerken M, Scharl A, Kölbl O, and Klinkhammer-Schalke M
- Subjects
- Adult, Aged, Aged, 80 and over, Endometrial Neoplasms mortality, Endometrial Neoplasms pathology, Female, Humans, Kaplan-Meier Estimate, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Ovariectomy, Postoperative Period, Registries, Retrospective Studies, Survival Rate, Treatment Outcome, Chemoradiotherapy adverse effects, Endometrial Neoplasms therapy, Neoplasm Recurrence, Local therapy
- Abstract
Purpose: Adjuvant treatment of high-grade endometrial cancer varies greatly due to the lack of definitive results from controlled randomized trials on the subject. In a retrospective study, we sought to investigate the influence of post-operative radio-, chemo, and radiochemotherapy on survival time and recurrence rates among high-grade endometrial cancer patients., Methods: 284 high-grade endometrial cancer patients (FIGOI-III, or unknown classification) diagnosed between 1998 and 2015 were retrospectively analyzed. All patients underwent surgery. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared for post-operative treatment modalities of radiotherapy alone (RT), chemotherapy alone (CTX), radiochemotherapy (RCT), and observation (OBS)., Results: Post-operative RCT and RT resulted in a significantly improved 5-year OS of 94.1% (HR 0.104, CI 0.013-0.809) and 62.1% (HR 0.615, CI 0.390-0.969), respectively, compared to 43.6% for OBS. CTX did not significantly improve OS leading to a 5-year OS of 56.5% (HR 0.783, CI 0.224-2.740). 5-year recurrence rate was lowest for patients treated with RCT (5.3%). 5-year RFS was 94.1% for the RCT group and proved to be significantly superior to 58.8% for RT (HR 9.034, CI 1.184-68.948), 56% for CTX (HR 12.738, CI 1.337-121.346), and 37.4% for OBS (HR 16.407, CI 2.127-126.575), respectively. In comparison with OBS, RT alone resulted in a significant improvement in RFS (HR 0.551, CI 0.354-0.856)., Conclusions: Our retrospective population-based study indicates a survival benefit from treating high-grade endometrial cancer with post-operative RCT. Randomized controlled trials are needed to minimize potential confounding parameters and further clarify the subject.
- Published
- 2018
- Full Text
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